Stopping AIDS

Patty Stonesifer shows how AIDS discriminates against the poor and says that this is the pivotal moment for tackling the spread of the disease.

Thirteen-year-old Claris Akinyi does not skip in the playground with her classmates any more; they will not play with her since her father died of AIDS. Of course, she has no time to play anyway, between caring for her mother, who is dying of AIDS, and supporting her four younger siblings with the dollar a day she earns selling corn.

Claris’ story is heartbreaking, but it is not rare. Her mother will become one of 22 million who have died from AIDS, and the five children mourning her will join more than 13 million orphaned by AIDS – most of them desperately poor.

AIDS can strike anyone, no matter what their station in life. But in a powerful sense, AIDS discriminates against the poor – those without the information, the resources, or the social leverage they need to protect themselves. Women are infected more than men, the poorest women most of all, and millions of mothers have tragically passed the AIDS virus to their children. Some 75 per cent of those living with AIDS – and 75 per cent of those who have died of AIDS – are African. And 95 per cent of all new infections occur in developing nations.

Global inequity
The Bill & Melinda Gates Foundation has looked carefully at the problem of inequity – in access to education, technology and economic opportunity – across race, countries and continents. But we have found no inequity more glaring and destructive than the inequity in global health. The developing world carries 90 per cent of the global disease burden, yet these countries receive only 10 per cent of worldwide health resources.

The death of a child in the developing world is every bit as tragic as the death of a child in the United States, Europe or Japan; and those of us who were born in the developed world have a responsibility to help those who were not. From a practical point of view, we believe improving public health makes it easier to meet every other need, from higher literacy, to better education, to stronger economic growth and a more stable, prosperous society. That means that when low-cost, life-saving interventions are available anywhere, they ought to be available everywhere. And when an AIDS vaccine is developed, we must ensure that it is within everyone’s reach.

The fight for a better future will be won or lost on the battleground of global health. If we can make the same gains against AIDS, tuberculosis and malaria that we have made in the past against smallpox, polio and other illnesses, we will literally save hundreds of millions of lives. And there is every chance that nations in Africa and elsewhere can make the same health and economic gains achieved by more prosperous countries like the Republic of Korea. But if we cannot meet these health challenges, there is little chance for change. That is why we have made global health the top priority of the foundation, and why we have made stopping the transmission of AIDS the foundation’s number one global health priority.

This is a pivotal moment. The 36 million people infected with AIDS could quickly become 100 million. It depends on what we do today. The foundation is working to fight AIDS in five ways, by:

  • Supporting the development of an AIDS vaccine.

  • Promoting education and prevention, particularly among those at high risk of infecting others or becoming infected with HIV, including commercial sex workers and intravenous drug users.

  • Developing new and effective microbicides that allow women to protect themselves even if their partners will not.

  • Supporting comprehensive approaches that reduce the spread of AIDS by increasing awareness, prevention, diagnosis and treatment.

  • Helping communities care for children orphaned by AIDS.

Naturally, any goal as bold as stopping the transmission of AIDS draws sceptics, who point to the raging epidemic in Africa and surging infection rates in India, the Caribbean, China and the former Soviet Union. But those numbers are merely evidence that the task will be difficult, not proof that it is impossible.

For the first time in 20 years, the excuses for ignorance and inaction are gone. AIDS is now debated in the world’s great forums. Kofi Annan’s leadership has given us – through the Global AIDS and Health Fund – a vehicle for measuring our financial commitments against the scale of the crisis. Governments, non-governmental organizations, corporations, multilateral organizations, and the top medical minds in the pharmaceutical companies and research laboratories, are fighting together on the same side for the same cause for the first time in history.
Increased investment is needed to accelerate research...
Successful prevention efforts are now under way in many countries. Each nation has its own social mores that can make prevention difficult to discuss. Yet courageous leaders are taking political risks to defy old taboos, push bold plans, end old stigmas and make dramatic improvements in the health of their nations.

In Thailand, Prime Minister Thaksin’s strong support of public health efforts to develop an HIV/AIDS surveillance system and a sustained public awareness effort – including the ‘100 per cent condom use’ campaign for commercial sex – cut infection rates of 21-year-old military conscripts by two thirds. A programme to test and treat women for HIV reduced the risk of mother-to-child transmission by two thirds.

Fighting back
Senegal, under the leadership of President Wade, has kept HIV prevalence at 2 per cent with intensive condom promotion, treatment of sexually transmitted infections (STIs), and success in delaying the age at which young women first have sex.

Uganda used to be one of the world’s examples of the hopelessness of AIDS. Today, it is an inspiring model of how to fight back. A broad-based national effort backed by President Museveni emphasizing condom use, counselling and testing, and STI self-treatment kits has dropped the overall adult HIV prevalence by nearly half, from 14 per cent to 8 per cent, in ten years.

In Mozambique, Prime Minister Mocumbi has spoken out with stunning candour about practices that speed the spread of AIDS, and the need to change habits in order to change the future. He freely admits it is ‘slow, painstaking work’, but that ‘surely, our children’s lives are worth the effort’.

The world has not covered itself in glory during the first 20 years of the AIDS epidemic. We underestimated the disease, millions died, and millions more are in danger. We now know what is at stake. We know what it will take.

Donor governments must increase the investments they have made to date as part of a worldwide effort to devote unprecedented levels of resources to global health. This will require ‘new’money, and not simply a shift of resources where funds for AIDS take from funds for malaria. Developing nations must follow the examples set by leaders such as President Joaquim Chissano of Mozambique who, during his term, has doubled that nation’s health budget. Dollars must flow to effective, proven interventions that target high-risk groups who can limit transmission of the virus if they receive the information and prevention tools they need. Finally, increased investment is needed to accelerate research on the development of HIV vaccines, especially for viral strains prevalent in highly affected regions.

It may be too late to give Claris a happy childhood, but we can still give her children a happy future – if we face the hard facts and take the right steps, together

Patty Stonesifer is Co-chair and President of the Bill & Melinda Gates Foundation, Seattle, Washington, United States.

PHOTOGRAPH: Franz Korbik/UNEP/Topham

This issue:
Contents | Editorial K. Toepfer | Answering poor health | Tackling water poverty | Everything connects | Up the gross natural product | Stopping AIDS | Whose city is it anyway? | Nutrition | At a glance: Poverty | Competition | World Bank Special: ‘Double burden’ | It’s not just, pollution | Smoke and fires | Breaking the cycle of poison | Pharmacies for life | Viewpoint: Change – or decay | The environment: why we must not give up | World Atlas of Coral Reefs | GTOS: An eyeglass on our planet

Complementary articles in other issues:
Kristalina Georgieva: Disproportionate effects (Beyond 2000) 2000
Madeleine K. Albright: Changing course (The environment millennium) 2000
Mark Malloch Brown: Empowering the poor (The environment millennium) 2000
Geoffrey Lipman: Travelling hopefully (Tourism) 1999
Leslie Roberts: Focus: Environmental degradation (Oceans) 1998